IMSc
in Nursing, Federal University of Rio de Janeiro, Anna Nery Nursing School.
Doctoral student at DINTER/Federal University of Pará/Federal University
of Santa Catarina/CAPES. Assistant professor at the Federal University of Pará.
Member of the History of Nursing and Health Knowledge Studies Group and Nursing
Education, Policies and Technology in the Amazon Group. Belém, Pará,
Brazil. silvioeder@ufpa.brIIPhD in Nursing. Associate Professor, Federal University of Santa
Catarina, Nursing Department, Graduate Program in Nursing. CNPq Researcher.
Florianópolis, SC, Brazil. padilha@ccs.ufsc.br

The objective of
this descriptive qualitative study was to analyze the attitudes of adolescents
before drinking alcohol. Interviews were conducted with 40 adolescents from
a support institution in the state of Pará. Thematic content analysis
resulted in the category: attitudes and behavior related to drinking alcohol.
Alcohol consumption is associated with fun, but it is also a way to avoid thinking
about problems. The adolescents used other types of drugs at times, but the
use of alcohol was unanimous. In conclusion, alcohol promotes socialization
and enjoyment for adolescents, and it may lead to abuse and the contact with
illicit drugs, such as marijuana, cocaine and thinner.

The consumption
of drugs is a cultural practice of human beings existing over the course of
human history and most social groups have lived with drugs over time. The abusive
consumption of psychoactive substances from the 1960s on became a public health
problem due to increased consumption among adolescents and the harmful risk
posed to the health of users, in addition to related social problems. The first
experiences with drugs generally occur during adolescence, since individuals
in this phase are vulnerable from a psychological and social point of view(1).

The meanings conferred
onto the use and abuse of drugs is not so much related to their chemical characteristics
but more to their symbolic attributes, to the social imagery and cultural aspects.
Drugs allow one to demarcate social domains, which constitute different realities
around certain standards(2).

The numbers presented
by the last World Drug Report (2005) from the United Nations (UN) reported approximately
200 million legal drug users in the world, predominantly adolescents. This tendency
toward increased consumption of alcohol and other drugs had already been reported
by a study presented in the book "Drugs in Schools" disseminated by the UN Program
for Education, Science and Culture at the end of 2002(3).

The use of alcohol
in Brazil varies from region to region. In the north of the country, the frequency
of use of alcohol reaches 8.4% among students and 12.9% of this segment of the
population frequently consumes alcohol in the south. Reporting of alcohol consumption
among the general population also varies within the Brazilian territory. The
population in the north reports more fear and insecurity in relation to alcohol
consumption than the population in the south. In general, individuals in the
south believe that alcohol is not too harmful to a person's health. It is interesting
to note that there is a culture of wine consumption in the south, due to the
presence of German and Italian cultures influencing knowledge related to drinking
and glorification of wine(4).

The prevalence
of alcohol dependency in Brazil was 11.2%: 17.1% for men and 5.7% for women.
The prevalence of dependency was greater in the north and northeast, with percentages
above 16%. A more disturbing fact is the evidence that 5.2% of Brazilian adolescents
between 12 and 17 years old were users and alcohol-dependent. This percentage
was close to 9% in the north and northeast. Another element that was revealed
by this household survey was the consumption of one or two drinks per week,
which is considered to pose a great risk to health by 26.7% of the respondents(4).

The consumption
of alcohol among adolescents is perceived as a severe public health problem
in Brazil. Studying this population is necessary to reveal their social representations
concerning the consumption of alcohol and understand their attitude and behavior
toward alcohol.

A social representation
can be understood as a form of knowledge, developed in the social milieu and
share within it, whose objective is to construct a reality common to a given
social group. It is called common sense, folk belief or natural and naïve
knowledge, which differs from reified or erudite knowledge, though it is also
considered an equally legitimate object of study given its importance in social
life and because it enables the clarification of cognitive processes and social
interactions(5).

Understanding the
social representations of adolescents concerning the issue of alcohol and, more
specifically concerning alcoholism, supports the acquisition of knowledge about
how these individuals understand this psychosocial object in their daily lives
and consequently how this understanding influences their practices. Such practices
can be identified as attitudes and behaviors adolescents adopt when faced with
alcohol. Based on this contextualization, we highlight the need to reveal the
universe of alcoholism focused on the history of life of these adolescents in
order to understand their attitude and behavior as adopted toward this drug.

OBJECTIVE

To analyze the
attitudes of a group of adolescents attending a support institution in Pará,
Brazil toward the consumption of alcohol.

METHOD

This descriptive-exploratory
study with qualitative approach uses the history of life method to grasp the
social representations of the studied individuals concerning the theme. This
method, which is a branch of oral history, is an authentic and efficient instrument
of investigation when the researcher attributes a scientific aspect to the study(6).

A history of life
consists of the subject's narrative and functions as a bridge of interaction
between the individual and the social milieu, the main characteristic of which
is a concern to establish a bond between the researcher and the subject. Hence,
production of meaning occurs both for the researcher and the studied individual.
A qualitative approach was chosen because it allows the investigation of the
object of study through grasping the subjective universe of a given group of
individuals. This modality of study is based on a dynamic relationship, an
alive interdependency between the individual and the object, an inseparable
bond between the individual's objective and subjective worlds(7).
Therefore, through the reports provided by the studied population, one identifies
the objective reality that surrounds individuals. The historical method allows
one to understand the universe of adolescents from their past, with the construction
of social representations concerning alcoholism, which are essential to their
attitude toward the social practice of consuming alcohol.

The study setting
was the Urban Tribes Project [Tribos Urbanas], a program of
the City Hall of Belém, PA, Brazil created two years ago to care for
young individuals and adolescents who become involved with gangs, taking them
from streets and including them in socio-educational activities(8).
Forty adolescents participated in the study: 30 male and 10 female individuals.
The inclusion criteria were: being between 12 and 20 years of age; attending
the program; and having the consent of the adolescents and their legal guardians
to participate in the study. Data were collected between March and July 2009.

Narratives to produce
oral sources were collected through semi-structured interviews, a technique
that is essential to data collection, since the narrative that emerges reveals
structural categories of principles, values, standards and symbols while at
the same time it also transmits through a spokesperson, the representation of
certain groups in specific historical, socioeconomic, and cultural conditions(9).
In studies addressing social representations, one needs to work with the social
group, since only through it is consensual knowledge elaborated. Hence, the
number of individuals participating in the study needs to be representative
of a group.

The saturation
of data technique was used. It utilizes the repetition of reports as a way to
limit sampling(10). The study complied with ethics principles established
by Resolution 196/96, the National Council of Health and was approved by the
Ethics Research Committee at the Federal University of Pará (protocol
004/08 CEP-ICS/UFPA). The interviews were immediately transcribed afterwards.
Thematic analysis was used to interpret information. It consists of significations
that emerge from the text, which enable interpretations based on the theory
that guides the study. This analysis technique enables one to know a context
through the communication of individuals linked to it(11).

The thematic analysis
was divided into three stages: the first is the pre-analysis that consisted
of selecting and organizing the material through skimming, reading and development
of the corpus; the second consists of exploration of material; and the
third stage consists of treatment of data(11). The following thematic
category emerged from the analysis: Attitudes and behavior toward the consumption
of alcohol, which was then divided into two subcategories: The consumption
of alcohol in various forms and situations and Alcohol: a path to other
drugs.

RESULTS AND
DISCUSSION

Attitudes and
behavior toward the consumption of alcohol

An attitude is
a psychological mechanism studied in relation to the social world and jointly
with social values: it refers to a specific position assumed by the individual
in one or more dimensions relevant to evaluating a certain social entity. One
way to measure attitude is by evaluating behavior. This type of indicator enables
one to overcome a lack of candid self-description, producing observations in
a natural environment, which would be impossible through bodily measurements.
Hence, the most important behavioral techniques in this domain refer to the
observation of behavior that reveal attitudes that go unnoticed by the subjects(12).
In other words, attitude is thinking and behavior is its concretization.

This category is
evidence in regard to the attitude and behavior of adolescents toward alcohol
and is divided into two subcategories: alcohol consumption in its various
forms and situations in which we observe that the most consumed drinks among
adolescents is beer during leisure and recreation; and alcohol: a path to
other drugs, in which the pleasant effects produced by alcohol lead young
individuals to use illegal psychoactive drugs such as marijuana, cocaine and
thinner.

The consumption
of alcohol in its various forms and situations

The alcohol used
in alcoholic beverages is ethanol, which is derived from the fermentation of
vegetables, fruits and grains. There is a variety of alcoholic beverages in
Brazil, among which is included beer, perhaps the most consumed variety in the
country. It has a lower alcoholic content, though its consumption is associated
with great quantities. When asked what were the alcoholic beverages consumed,
part of the interviewees reported consuming only beer as shown in the following
reports:

I only drink
beer, I always drink when I go to parties every weekend. I don't drink to
get drunk. One of these days I went to a party and there was this boy who
asked me to chug it all, I said I wasn't that alcoholic to chug a whole beer!
I drink in a party only to have fun, to have fun really! There are people
who drink to get into trouble, I don't, I get quiet and don't mess with anyone.
And I go to the party around midnight and leave around three in the morning;
I drink only two cans so I don't get drunk. The party gets better after I
drink (E1).

I only drink
beer when I'm at parties with friends, but I drink only to enjoy the party
and during weekends (E4).

I drink beer.
I don't drink much at parties but when I fight with my boyfriend or my mother,
then I drink a lot, I drink because I get hurt and want to forget problems
(E6).

Beer, I drink
at parties, I go once in a while, once, two or three times a month. I drink
until I have no money left. I don't drink at school, at home my mother doesn't
drink, only my stepfather, but it is not every weekend. We don't get along,
he treats me badly doesn't matter if he is drunk or not; I like my mother
best (E11).

The consumption
of alcohol among the interviewed adolescents is, for the most part, associated
with recreation and fun, though it is also a way to forget problems for some.
We also identified that because they consume only beer, they do not see themselves
as alcoholics. According to their conception, for someone to be considered an
alcoholic, one has to consume not only one kind of alcoholic beverage,
but a diversified set of alcoholic beverages.

It is worth noting
that any alcoholic beverage when inappropriately consumed can cause chemical
dependency and, additionally, its toxicity can cause severe damage to health
with the onset and/or aggravation of diseases and greater incidence of traumas
and/or injuries; psychological and psychiatric problems that include aggressiveness,
depression, anxiety and psychotic crises related to alcohol; social and interpersonal
problems; and family conflicts related to domestic violence, which are a result
of a variety of physical and/or traumatic psychological effects, both in the
short and long terms, among the family members of the irresponsible consumer(13).

Another point to
highlight is that the consumption of alcohol is closely linked to social interactions.
In many situations, the indiscriminate consumption of alcohol increases due
to easy access, and in others, this process occurs because the environment favors
more conditions of consumption, such as the case of aparelhagem(a)
parties, very common in the state of Pará, where adolescents have easy
access to alcohol. Alcohol consumption has an important meaning for them, that
of being a member of one of the groups attending the party. The following reports
confirm such a view.

I drink beer
and wine, and I only drink at parties, but not much, two glasses and that's
it. I go to parties every weekend. I like those aparelhagem parties (E3).

I drink beer
and wine, I go to those aparelhagem parties, but I kind of stopped going to
these parties, sometimes I feel like going, but I don't anymore. I stopped
when I started attending the program. I distanced myself from my friends (E10).

I drink alcohol,
beer, wine and sometimes cachaça, but mostly wine. I drink mainly at
parties, I go once, twice a month, not every weekend, I go to aparelhagem
parties, the best one is Superpop. I've already got drunk at home, at school,
I've already got really drunk at school. It was the birthday of a friend of
mine, so we bought a bottle of wine and a bottle of cachaça and got
drunk there, then at the end everybody was drunk and was sent to talk to the
principal. We were drinking behind the school, where there was this very big
bush and we went to drink there (E12).

I drink beer
at parties and also scotch. I only drunk once at school, I'd loaned my card
to a boy, he didn't want to give it back, so I stabbed him. I only drink alcohol
when I go to aparelhagem parties on the weekends (E16).

The variety of
alcoholic drinks consumed by adolescents is mostly focused on beer though they
also consume hard liquor, such as scotch and cachaça, wanting the increased
alcohol content. These adolescents consume alcohol mainly on weekends, at the
so-called aparelhagem parties that include huge boxes of speakers distributed
in a closed area where regional music, such as technobrega(b),
is played.

The reports indicate
that adolescents understand social interaction to imply the consumption of alcohol,
since for the adolescents to be included in a given social group they are required
to experiment with new sensations, among them, the consumption of alcohol. Simply
attending a party implies the consumption of alcohol, a fact identified in most
of the reports.

Adolescents with
their specific ways to behave, act and feel can only be understood from the
relationship established between them and adults. This interaction is established
according to the objective conditions of the culture in which it is inserted.
Different historical, political and cultural conditions produce transformation
not only in the social representations of adolescents but also in their inner
world.

Adolescents should
be understood in the context of the society in which they live, because the
individual and society are interlaced. Sometimes, the relationship between the
individual and society appears as an interaction between separated entities.
Sometimes, the individual is characterized as a mere reproduction of society,
and other times, as an independent entity as if there was a parallel between
them. Subjectivity however is constructed in the social and cultural organization
in which individuals are included. It has not always been understood as such,
since the private has also been perceived as subjective in the sense it was
independent from society. The basic elements that constitute psyche- affections,
desires, emotions and will- were seen as independent from society and inherent
to the self(14).

The ability to
interact with people is related to the individual's social skills, which in
turn ease the establishment of closer relationships with people. Hence, a lack
of social skills can hinder individuals from adapting to their milieu, with
consequences such as difficulty in making friends and the development of anti-social
and risk behaviors. Adolescents who are socially accepted by their peers receive
reinforcement, which improves their adaptation not only in the social sphere
but also in the personal and academic areas. We ascertained that social behavior
among adolescents is often centered on the consumption of alcohol with their
peers.

This subcategory
highlights the consumption of alcohol, predominantly beer, and also that adolescents
do not categorize this type of beverage as one for daily consumption. The adolescents
believe that this type of drink does not lead to chemical dependency, though
since it contains alcohol, its abusive consumption can cause problems in addition
to chemical dependency.

Alcohol: a path
to other drugs

Alcohol is a drug
even though society does not consider it as such; its consumption is considered
legal in certain situations and forbidden or not recommended when it poses some
risk to consumers or to the public order. In this context, alcohol appears as
the first drug with which children and adolescents have contact and, depending
on forms of consumption, it can be the doorway to other drugs, which is confirmed
by the following reports:

I drink only
wine now, but like, I drink two glasses and stop because my girlfriend doesn't
allow me. I only drink when we go to the square to skate, sometimes at birthday
parties on weekends. I've never drunk at school but I have many friends who
take alcohol inside their backpacks to school and when we went to the court
to play ball they'd drink. When I used to go to parties, there were also a
lot of drugs: marijuana, cocaine paste. I started to go to parties at the
age of 17, at 18 years old I used to drink a lot of alcohol at parties, I
got drunk at home many times, like falling down. I've already fell from my
motorcycle because I was drunk, but nowadays I drink only on the weekends,
only when I'm in the mood. I don't drink everyday like I used to and don't
smoke marijuana and cocaine anymore (E2).

I don't drink
at home because my grandma won't let me but at school I used to drink with
friends. I have many friends who drink alcohol at school. Sometimes, we smoked
marijuana or did cocaine paste. Recently I got some sense and stopped a little
going to parties. I used to go to parties very frequently and there were a
lot of drugs available, like paste, powder (E7).

I used to drink
a lot of alcohol with my friends; we also used marijuana and thinner so we'd
get even more stoned (E22).

The previous reports
confirmed something already expected because this is the reality of many underdeveloped
countries. The fact is that many young individuals initiated consumption of
alcohol such as beer and wine and then, after getting into contact with ethanol,
they started using illegal drugs, usually paste and powdered cocaine. In addition
to the mentioned drugs, many adolescents also reported using thinner, a solvent
used for paint and varnishes, usually found in auto shops, which when inhaled
has effects similar to shoemaker glue, such as lethargy and hallucinations.

An important fact
to note in the reports is that many of the adolescents mentioned the use of
other types of drugs though they allege to have stopped consuming illegal drugs
and remained with alcohol, beer and wine being the most frequent types. This
conception reinforces the popular imagery that alcohol is not actually one type
of drug, whether because of its legal nature or its historical consumption.

The adolescent
is in an age group of greater vulnerability to experimentation and the abusive
use of psychoactive substances, both legal-alcohol and cigarettes-and illegal
ones(15). The vulnerability of adolescents (experimentation and early
use) is in general related to several factors inherent to youth-perception of
omnipotence, search for new experiences, being accept by their peers, independency,
challenging the family and social structure, and psychosocial and existential
conflicts-, as well as aspects related to the family such as structure, support,
and drug addiction(16).

The use of drugs
eases socialization and is a language used in the adolescent process, however,
when it occurs in an abusive way, it becomes a problem that may have repercussions
for the future lives of individuals. Even though the attention of adolescents
is not focused on their home but on the groups of friends and colleagues, to
understand adolescents one still has to insert them into the sociocultural context
linked to the culture that provides the bases for their development(17).

There was this
time a boy gave me marijuana for me to try, I was 13 years old. I went to
invite him for a walk and he said he didn't want because he was already stoned.
He said: 'I have something for you' and gave it to me and I didn't know what
it was, but when I smelled it, I realized it was marijuana, I said I didn't
want it, but he'd already put it on my hand and I had no way to give it back
to him, so I smoked it a bit (E23).

I had bad influences
more in the streets, out of school. You know, my buds would call me to play
ball and I'd go and they'd be smoking marijuana and drinking and I used just
to watch. But I got angry at the death of my mom and started using it too
(E2).

Some friends
offered me marijuana when I was 14 years old. I didn't want it but they insisted
until I smoked it, which was what happened. After marijuana I also used powdered
and paste cocaine (E34).

Adolescents' risk
and protection factors related to alcohol and drugs are identified in all spheres
of life: in the individuals themselves, in their families, in their group of
friends, at school and in communities. Such factors are not isolated; there
is considerable social influence. For this reason, the risk is greater among
individuals dissatisfied with their quality of life, who have deficient health,
do not have accurate knowledge concerning drugs, have easy access to these substances,
and live where there is a lack of community integration(18).

This subcategory
enabled the understanding concerning how adolescents consume alcohol and how
it leads adolescents to consume other drugs such as marijuana, cocaine and thinner.
Diverse strategies needed to be devised to prevent the use of alcohol and other
illegal drugs.

CONCLUSION

The use of the
history of life method centered on the Social Representation Theory was relevant
to understand the universe of alcohol consumption on the part of adolescents
as well as how they relate it with their daily life.

This study enabled
us to understand the attitudes and behaviors of adolescents toward alcohol,
the role it plays in socialization, and according to social imaginary, how it
provides pleasure. Moreover, it also demonstrated how alcohol consumption can
become abusive and lead to chemical dependency.

Alcohol is abusively
consumed by adolescents and such consumption provides them a pleasure they seek
to intensify with the use of harder drugs such as marijuana, cocaine and thinner.
Hence, alcohol has been shown to function as a drug that eases access to illegal
drugs.

The use of alcohol
among adolescents is a controversial issue in Brazilian society and academia.
At the same time the law forbids the sale of alcohol to those younger than 18
years of age, its consumption is a common practice among young people, whether
at home, parties or even in public places. Society in its entirety adopts paradoxical
attitudes in relation to this topic. On the one hand, it condemns the abusive
consumption of alcohol by young people but, on the other, permits its consumption
to be encouraged through advertising.

*Extracted
from the dissertation: "História de vida e alcoolismo: representações
sociais sobre o alcoolismo", Graduate Nursing Program at the Federal University
of Santa Catarina, 2010.

(a)
T.N. Aparelhagem parties are similar to rave parties though regional music from
Belém do Pará, PA, Brazil where these are mainly promoted, is
played. The dynamics of such parties is very particular including the way beer
is served. People do not buy individual bottles or cans of beer; they buy beer
in buckets of ice from waiters circulating throughout the saloon. Different
groups (tribes) attend these parties and the group identity stands out more
than one's individual identity.(b) Typical music of
Pará, Brazil.